A Flipper Shouldn’t Be Your First Choice: Alternative Implant Provisional Restorations

When a patient needs a tooth to be extracted and an implant is planned, and if the tooth is in the esthetic zone, the restorative dentist will almost always need to use a provisional to meet the patient’s esthetic demands.  But all too often the dentist will rely on a flipper (provisional removable partial denture) to temporarily fill the space.  This is sometimes the worst possible option available.

The best possible option in ideal circumstances would be to immediately load the implant.  I’ll discuss why in another post but I’ve already discussed my technique in this post.  But the point here is that we frequently are not allowed to immediately load the implant and must find a way to temporize that does not involve engaging the implant.

I do still use flippers as provisionals!  Sometimes it is the best option in less-then-ideal circumstances.  But I only resort to a flipper when I’ve exhausted the possibility of using a better provisional.

First let’s discuss the two main qualifications for a great provisional:

(a) Fixed, Not Removable – It is always better to have the temporary be doctor-removable.  Cement will guarantee that the patient cannot take it out on their own.  Not only do patients like that, but it will help preserve any emergence profile sculpting you’re doing.  Which leads me to…

(b) Pontic Contouring – Implants are cylindrical; teeth are not.  To achieve the ultimate in esthetics, you must preserve or reclaim the gingival contours that surround teeth and roots.  I discuss how to do this with a customized implant temporary abutment in this post. However you are at an advantage when you can begin to sculpt the three dimensional emergence profile in the provisional stage.

Let’s quickly run through the four choices we have.

(1) Fixed Partial Denture (Bridge)

This is my number one choice!  Here’s why:

Pros of FPD

It’s fixed in place with cement; I can remove it when I want to but the patient cannot.  It’s tooth-supported, so that means there’s no unpredictable pontic pressure on the soft tissue.  Since it’s tooth supported and retrievable, I can contour the pontic site exactly the way I want.  I can add and subtract material over time, developing a gorgeous emergence profile for my future implant.  As an added bonus, I have a lot of control over the lengths of the interproximal contacts because, by definition, the adjacent natural teeth are being committed to crowns.  Therefore if I don’t generate the papilla height I’d like to see, I can easily just lengthen the contacts to prevent the dreaded black triangle.

Cons of FPD

But that is also the greatest problem with the FPD provisional: I can’t always commit the adjacent teeth to crowns.  I will not prep virgin or mildly restored adjacent teeth for an implant provisional under most circumstances.  This is the greatest limiting factor with this technique.

(2) Resin-Bonded Bridge

Also known as the Maryland bridge, the resin-bonded bridge is not frequently used as a permanent restoration due to concerns over long term bonding.  However, it’s utility as a provisional is underrated.

Pros of Resin-Bonded Bridge

Like the FPD, it’s fixed in place and tooth-supported.  So we have a happy patient and no unpredictable pressure on the soft tissue.  Notice the perforated “wings” in the second picture.  Having experimented with a few designs, I’ve found the perforations make the provisional easier to remove without sacrificing retentiveness during normal function.

Also, the adjacent teeth are not converted into crowns, which is a big plus.  This is an extra-coronal retentive element, so no preparation of the adjacent teeth is necessary.  Just make sure the patient’s occlusion permits the thickness of the wings.

Cons of Resin-Bonded Bridge

Unfortunately, these are still unpredictable to remove.  This means taking it in and out to play with the emergence profile is more challenging.  There is a chance you will fracture one of the retentive wings as you remove it.  I’ve even had to cut these off because they are so well bonded into place.  Either way, you sacrifice the resin-bonded bridge and will need a back-up to send the patient home with.  I’ve tried using different cements but they really don’t work.  You must etch and bond these into place to prevent them from exfoliating.  Also, be very careful if you’re inserting one over a fresh surgical site.  In the image above, you can see I’ve used a rubber dam as a barrier to the etch I’m about to use.

(3) Essix

The Essix has proven to be a useful tool in my armamentarium, but I’ve learned to only use it in the short term.

Pros of Essix

This is very cost effective.  You can easily fabricate one in your office using a Vaccu-form machine in a pinch.  But if you want these to last a while, have a dental lab make one using a strong material.  It must be rigid and thick; no bleaching tray material allowed if you want it to last.

Can you contour pontics?  Kind of.  Yes, you can, because it’s easy to add or subtract material to the tooth sitting in the tray.  But, no, you can’t, because this is a removable appliance.  Patients are theoretically supposed to remove this when they eat, sleep, and do home care.  If they’re doing that like they’re supposed to, the soft tissue can rebound.  Tissue contouring with an Essix is not as predictable as an FPD.

Cons of Essix

Yup, it’s a removable appliance.  And the reason you want them to take it out when they eat and sleep is that it will fracture.  Usually right in between # 8 and 9.  I tell my patients that an Essix is kind of like Invisalign to describe the slight problem with ethetics.  It’s bulky, it can affect speech, and you should remove it when you eat; all esthetic issues.

Does it place unpredictable pressure on the soft tissue?  Sometimes.  Yes, it is technically tooth-supported.  If you’re using a rigid material and only one tooth is missing, then you’ll probably be alright.  However the longer the span and the less rigid the material, the more the appliance will bounce up and down on the extraction socket/graft/implant.

(4) Flipper

The acrylic removable partial denture is very commonly used but offers only one real advantage…

Pros of Flipper

…it’s cheap to make.  A lab can make this quickly and inexpensively.  That is the only advantage in my book.

Cons of Flipper

The main problem is that it is tissue supported, thus it places unpredictable soft tissue pressure on the pontic site.  This can lead to flattened gingival architecture, graft dehiscence, or even implant failure if it can engage a recently placed fixture.

Being soft tissue supported and removable, you definitely cannot do any pontic contouring.  Not gonna happen.

Notice that I listed esthetics as a con.  Some of you may say that a nice flipper is capable of recreating beautiful, pink acrylic papilla.  Very true.  But look at the above picture.  If the patient has a high smile line, then your esthetics are down the drain.

But even more important is the false promise of papilla.  Even with a more normal smile line, you may be promising your patient a papilla in the provisional that you cannot deliver in the final implant prosthesis.  If you need pink acrylic to make the provisional look good, that’s a good indication that you should do some hard and/or soft tissue grafting to restore missing periodontal anatomy.


UPDATE: Check out this post on Snap-On Smile to see why I’m using it more and more in my practice.

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  3. M. Shoaib Khan says:

    I have had some success with denmat’s snap – it bridge as well. Would recommend you give it a try.

    • Chris says:

      I’ve used it a couple of times and it is a nice alternative. The lab fee is the only drawback as it is more expensive than the other options.

  4. Sally W says:

    Last year my tooth #2 was extracted (with socket preservation) but I was not missing it and decided against the risk and cost of an implant to replace it.

    The first molar is now also a total loss situation.*

    I must have it extracted as it has abcessed. This makes me Kennedy class II and there seem to be very few options to hide my missing toothness while that heals and then while I attempt an implant, a long process and a long while of being toothless.

    I have no idea what to do.
    An essix-style retainer with a glop of composite for a tooth seems my only reasonable optionuf. I’m not looking forward to talking funny and being uncomfortable and not being able to eat in front of people.

    Is there anything else? All the dentures and flippers and maryland bridges I’ve seen demand a gap between two teeth, or else terrifying cantilvering and wires and hooks all over the palate.

    Isn’t there anything better? Could maryland with only one wing be used to stick a short molar on the premolar for cosmesis? I’m fine eating on one side for a year.

    If you have any ideas, time is short for me. The tooth come out any day now.

    * A 15 yr old post and crown has gone bad and I have heen advised against re-treatment. The apical end has shown some monkey business (a tiny cloudy bit) for a few years, but was asymptomatic.

    • Chris says:


      Thanks for your question! Yes, your options are pretty limited. Of course, it is difficult for me to make suggestions without doing an exam myself, but I can think of another option. What is the status of your second premolar, #4? You may consider a provisional crown on #4 with a distal cantilever into the #3 site. The occlusion on the pontic would have to be reduced and you would have to stay away from eating on that side as much as possible during healing. And even then, you should expect to have to visit the dentist every now and then for the provisional to be re-cemented. But this would give you a fixed provisional that would fill the #3 site for cosmetic purposes.
      Ultimately, you are also adding the cost of a crown to #4 in addition to the implant work behind it, but that may be worth it to you to stay out of a flipper.

      Hope that helps,

      • melinda says:

        Yes I was winding I have one of mg front teeth gone and I was looking to get something I can afford I hate going around with no tooth are they any suggestions that is cheap please explain to me different types of partials and the prices please and tha k u so much

        • Chris says:

          There are many different options, as you can see, that will either serve as a short-term or a long-term solution. Unfortunately it is impossible to quote fees for these services without an exam, x-rays, and other diagnostic information. I recommend going to Mouthhealthy.org and looking for a dentist near you. Best of luck!

  5. Pingback: Snap-On Smile as an Alternative to a Flipper | The Curious Dentist

  6. Denise says:

    Okay I’m a little confused. I went to my old dentist yesterday. I only went to them because they are the ones who put my cap on #7 tooth(which is a little loose now) and I thought all they had to do was re-cement it back. Well the dentist says that he can’t tell by the x-ray but he ‘thinks’ the support under the cap broke and my two options are a bridge which will damage the #6 and #8 teeth or an implant ($2500). If the support underneath is broken, wouldn’t my tooth be very loose? I can’t see why it can’t be cemented back. I’m a secretary and I can not have a missing front tooth!! Need a cheaper way to go that will look presentable. Please help!

    • Chris says:

      It sounds like there is a serious problem with that tooth, most likely a lot of decay. The root may be strong, so the tooth may not be loose at all. However the crown on top of the root cannot be predictably re-cemented on a bad foundation. Talk to your dentist to understand why the dentist believes the root cannot be saved. He will make sure that you have a temporary tooth while you heal from the extraction, so you never have to walk around toothless!

      • Lily says:

        A temporary tooth on a broken crown? My tooth fractured and then my crown fell off. I could see the tooth inside the crown, and there was just a small bit of tooth remaining on the gum.. He extracted the root and all that was there and told me I can get a flipper, but it takes 6-8 weeks to get insurance approval! No temp nothin! How would they put this in? Imagine. I am a teacher and suddenly no front tooth. Horror of horrors. My lips don’t cover my upper mouth. He did not indicate there was any sort of temp thing that could be put in.

        • Chris says:

          Sorry to hear about that, Lily. There are ways to temporarily give someone in a bind. I will often make an Essix appliance in my office to get someone through a couple of weeks while something more long-term is being made.

    • Tee J says:

      What location is that where your implant will only cost $2500.00?

      • Chris says:

        In case Denise doesn’t respond, I’ll say that $2500 for the implant, abutment, and crown does seem a bit on the low end. Perhaps her dentist was just quoting part of the fee?

  7. judy hoffman says:

    How much should a flipper with 1 tooth cost?

    • Chris says:

      There’s a bit of a range, but I’d say the average price is in the neighborhood of $300.

      • Kay says:

        $300.00 For a 1 tooth flipper – is that a lab fee or the dental fee? My dental office just quoted me $639.00.

        • Chris says:

          That is the lab fee. Dentists also have to charge for their staff, materials, and time.

          • Terrance says:

            Depends your insurance coverage (if applicable) and what they are willing to cover. I am in the process of getting a flipper as well. I just paid my partial co pay 0f $200.00 and will pay the rest once they do the procedure. I think with extraction + flippe procedure will be total 450 something w my insurance.

          • Chris says:

            Terrance, you are right that it depends on your insurance. Some companies will cover the flipper and then not pay anything towards the implant. Insurance companies are sneaky… talk to your dentist and the office staff about these possibilities.

  8. Juli says:

    My dentist tells me that one of my front teeth needs a flipper until an implant… how long does that take…and are they hard to wear…will it look diffeent than my other fron tooth and can you see the hardware.
    Not sure about the soft tissue problem..

    • Chris says:

      Sometimes a flipper is the best option for a certain case. Talk with your dentist to see if there might be another option that would work for you. Some patients find flipper to be a little uncomfortable but they do tend to look good. You’ll need to wear it for 4-6 months while the implant heals. If the implant cannot be placed the same day that the tooth comes out, then you’ll need an additional 3-4 months for graft healing.

  9. Misty says:

    Hello , I am considering getting a flipper …but not to replace a missing tooth. I have a large gap between my two front teeth and I think it’s just awful! I cannot afford braces and lumineers to fix it. I went to the dentist today to get my teeth imprinted to get the flipper. I don’t know much about it yet .i go back in 3weeks to test a removable flipper and decide if I should get a perminant flipper…please give me your thoughts on my situation . Thanks, Misty

    • Chris says:

      This is very interesting. It sounds like your dentist is trying in a mock-up in wax to test the cosmetics. If you don’t think that looks good, you could also try Snap-On Smile. It’s a great “long-term temporary.” It’s always better to get definitive treatment done, but if finances are limited you may want to discuss it with your dentist.

  10. Agnes says:

    Hi Chris,

    I would be doing the essix retainer for one of my pt. How do you secure a tooth in this retainer? Do you use composite material to fill the space or just acrylic denture tooth?
    Thank you

    • Chris says:

      Hello, Agnes! You can do both. If the tooth is already missing, you’ll probably need a denture tooth to fill the space. If the tooth is still present and is about to be extracted, you can make the Essix on a model and then fill in the pontic with the material of your choosing. Just remember that an Essix appliance isn’t great for long-term provisionalization (6 months or more) since they tend to break. These are great to use in the short term.

  11. Sandee says:

    Hi Dr. Chris,

    My number 8 tooth had to be removed last week and I was fitted for a flipper prior. I am 47 and both #8 and 9 suffered trauma when I was 10. They both ended up having to have root canals soon after. They were finally crowned about 5 years ago and I was so happy, thinking it’s all done. Well, last month a root canal was re-done to #9 to try and save it. #8 had abcesed and had to be extracted. I was told that I have bone loss on the front area and now I will have to have bone grafting done prior to the implant. I have to have this flipper for 9 months! I was told that I have to take it out to eat so this is very depressing to a social woman who enjoys eating out sometimes. A bridge is not an option due to #9 being crowned. I am not liking this flipper at all and I talk funny. I am stuck with this long term and confused about eating because I have heard you CAN eat with a flipper. My dentist said I really shouldn’t eat with it and that bacteria can begin hurting my other teeth pretty quickly. What say you? Also, my flipper is nicer than the one you have pictured. There is no fake gum above it and nobody can tell it is a fake tooth. One big plus anyway. I’d love any suggestions or advice. Thanks!

    • Chris says:

      Hello Sandee! Patients can eat with flippers but they must be careful if there is bone grafting underneath. Since you have had that done, you need to be vary careful to protect it! If you’re out with friends and need to eat, try to cut up your food more with a knife, then chew only with your back teeth. Alternatively, you could consider a Snap-On Smile, which I wrote about here.

  12. Al Paterno says:

    Dr. Chris,
    I am 60 yrs of age. I fractured #12 last week eating a potato chip. My dentist said fractured perfectly in half up to gum line. I have no pain at all unless I chew on or near. Due to tooth health of #11 and #13, my Dentist says no bridge. Perfers implant for me. My insurance says they do not cover implants they will only cover bridge or partials! I have low smile line and not concerned about esthetics. I cannot afford out of pocket implant at this time. Are there any repair options for fractured teeth? Any suggestions to temporily replace #12 if extracted until I have finances for an implant? Thank you in advance.

    • Chris says:

      Many insurance companies don’t cover implants. This is unfortunate because implants are often the most comfortable, cosmetic, functional solutions for certain cases. They can even be the most cost-saving in the long term. If you are able to work out an arrangement with your dentist to make the implant affordable, that would be the best course of action. If that still isn’t financially possible, you can discuss what temporary solutions might work for you. There are a few ways to give you something temporarily while you save up for an implant but the best option really depends on the status of your broken tooth and the adjacent teeth.

  13. adrian says:

    I love the flippers. I play a lot of hockey, so I’m used to losing teeth. I considered getting an implant, but I think it’d hurt way more to get an implant punched out VS a real tooth.

    • Chris says:

      Adrian, you raise a great point. I think that flippers are a great option for the select group of people like yourself who are at a higher risk of tooth trauma. I might suggest you look into Snap-On Smile as a more comfortable alternative.

  14. ellen poe says:

    I do not have dental insurance. I had a #7 removed and bone graft done last week at the cost of $1,161.00. I paid $450.00 for a flipper. As well as these expenses, I have had to pay for x-rays, consults of every nature… antibiotics, and pain medicine (which I never needed to use) My dentist is talking about an implant at the tune of $5,000.

    I simply cannot do an implant.

    We have discussed a bridge at the tune of $3,090.00.

    My teeth have bridges, crowns, and root canals of every sort.. thanks to the United States Air Force… back in 1989. My top teeth are not real teeth…

    I have been to several dentists and even to some denturists to see what my “permanent” options are.

    • Chris says:

      Ellen, I’m sorry to hear that finances are an issue for you. That is pretty common these days. My suggestion is to talk to your dentist about payment plans to get the care you need. An implant and a bridge are both fine options. There is certainly nothing wrong with speaking with other dentists to get second and third opinions. It sounds like your particular case could have several solutions. That’s a good thing! It’s good to have options, but it can get overwhelming when you get different advice from professionals. The only option I would avoid is a denturist. They are not dentists and they only have one solution: dentures.

  15. Kim says:

    This is interesting. I had a root canal started on my tooth in front (next to the big one on top) and never had it filled (instead of post cap and crown) so anyhow, it broke off from an accident but small part left and root intact. I was hoping to get post cap and crown but dentist said root wouldn’t hold because of some decay so suggested a bridge but didn’t want to file down two healthy teeth. He said best choice would b implant but not covered by insurance although bridge is. I’m going to suggest resin bonded bridge and see if they offer this so at least it may be covered by insurance and will not ruin my other teeth. Thx

    • Chris says:

      A resin-bonded bridge may be a good option for you for the mean time. I don’t like to use them as “permanent” restorations that are expected to last for many years. However I am comfortable expecting them to last for a few years, say five years at most. They can last longer than five years, but there’s a reason why they haven’t replaced traditional bridges as a long-term restoration. Bridges are far more predictable in the long-term.

      • Kim says:

        I do plan on getting an implant in the future, however, I’d have to do what my insurance covers now but only if it can be reversed. A traditional bridge does not allow for that and I’m afraid that it may cause problems for the other teeth used to anchor it as they must be filed down. Is it safe to say that the bridge with wings can be used now and then taken off in a couple years to be replaced with an implant?

    • Chris says:

      Kim, it sounds like you and your dentist have a great plan in place.

  16. Gary says:

    Hi, I am getting an implant og tooth #7 and I am missing a tooth on #8 that does not have enough bone left to do an implant. The plan is to graft and set the implant on # 7 and crown #9 and use a bridge for #8. This will take up to 9 months before the implant can be set. My dentist only does flippers. I am intirested in the snap on option and was wondering if you know a dentist in Seattle, WA. that does the snap on smile? And if it is possiable with tooth 7 & 8 missing?

    • Chris says:

      Gary, did you speak to your dentist about using a Snap-On Smile? I would be happy to speak with him/her about it to see if you are a candidate.

  17. steve says:

    came accross this site searching for affordable options im about to loose both #10 and number 8# I am freaking out about the cosmetics at 44 yrs old and in sales… really dont see affording implants though my insurance indicates they cover at 50%, a flipper is what has been suggested by my dentist i read about abudtment bridges is this the same thing a maryland bridge ? how good a long term soulution is that ? and could snap on work for me ? if a flipper is my dentists long term solution for me would the snap on smile not be just as good as a flipper in terms of longevity

    • Chris says:

      Hello Steve. An implant or a full coverage bridge would both be good long-term options for you. Which one is better depends on your clinical situation and your preferences, both of which your dentist can discuss with you. There is also convincing research that a Mryland bridge (not full coverage, only covers the back of the supporting teeth) can be an excellent long-term solution.
      Flippers and Snap-On Smiles are not long-term solutions for me. I use them to fill the space while an implant is healing. My preference is to use a Snap-On Smile in these cases for several reasons I mention on this site. I do not recommend using flippers and Snap-On Smiles for the long-term although they can hold up well for quite a while.
      If your insurance covers 50% of the implant procedures then that is actually pretty darn good! I don’t know your financial situation, but I recommend making the investment in a good long-term solution that you won’t have to worry about breaking, falling out, etc. Good luck!

  18. Nancy says:

    Hello Chris,

    Here goes my long story… I am 23yrs old & 6 months pregnant with my 1st child. When I was 12, I fell and fractured my two front teeth. 3-4 yrs later I had crowns done on both.Then in 2009, I had surgery/root canal done because I had pain & developed an abscess on my gums. I thought I’d be good forever but now I’ve developed another abscess :( my dentist said that there’s not much that can be done, therefore I need emergency teeth extractions because the infection can/will affect my baby.Do you really think I have no other options that may help save my teeth? She said I’ll be wearing a flipper for about 6 months but I’ve heard that it affects speech and they have to come off when eating or sleeping :'( This by far is the worse experience! :(

    • Chris says:

      Nancy, sorry to hear about that. Let your dentist know that you would like to avoid a flipper. You may be a candidate for alternatives such as Snap-On Smile or the others discussed in this article. Sometimes there is no alternative and a flipper is the only option, but it’s important to have the conversation with your dentist!

  19. kenya says:

    hi ive had a front tooth removed my dentist say i basically have nothing to grab hold to so i have to do bridge or flipper im 36 is there anything else and im in detroit my bridge cost 2000 he never said anything bout implant plsssss help.

    • Chris says:

      You may or may not be a candidate for an implant depending on your medical history, amount of available bone, etc. Ask your dentist about an implant option! If you are uncomfortable with his response, you are entitled to get a second opinion.

  20. Lois Jordan says:

    I lost a tooth due to a fall. My dr want to do an implant. I have a flipper in the meantime. When the initial surgery is done do I wear a flipper until the healing has taken place before the crown is put on? I am concerned about my appearance since this tooth is in the front of my mouth. Also ,what is a snap on smile. Would that work for me on a permanent basis?

  21. Lois Jordan says:

    When the initial implant surgery isdone do I war a flipper until I am ready for the crown? Am I candidate for a snap on smile?

  22. Lois Jordan says:

    After the initial procedure what is the typical time out with bruising, etc?

    • Chris says:

      You will require a temporary tooth after the implant is placed. This tooth may be the flipper you currently have or an alternative. You should speak with your dentist about your options and expected course of treatment. Typically the implant placement procedure is quite comfortable for patients and there is minimal post-operative discomfort.

  23. Jon says:

    I have a front-bottom/middle tooth that I will be replacing with an small implant. My dentist said that since both teeth on either side have had root canals work it would be better to take our the front 4 teeth and put in 2 larger implants. This is in place of just doing the 1 tooth with restoration. The problem is this I have a very bad hyperactive gag reflex. I can not be without teeth for my job. I do not feel that the flipper will work.
    Is this one for the books or is it!
    Please help.
    Thank You.

    • Chris says:

      Hello Jon! Ask your dentist about alternatives for your temporary. You may be a candidate for something like Snap-On Smile. The good news is that even a traditional flipper may not trigger your gag reflex since it will replace your lower front teeth. Your dentist may be able to design the flipper so that it has minimal material towards the back of your mouth.

  24. Mithila says:

    Hi Chris,
    I broke my front 2 teeth(#8,#9) when i was 9 years old. I had a root canal and crowns done then and i never had any problems until Aug 2009 which was 18 years later.

    I had to replace the crowns and they found some infection (though i did not have any pain or discomfort)the doctor suggested a Re-RCT on both #8 and #9. And after 6-8 months of re-RCT when i had a checkup the doctor said #8 is not showing any recovery and we will do a apicoectomy. Though i requested him to check on #9 he said he wouldn’t touch it as its showing signs of recovery.

    In Dec 2010 after he said all is well, i had the permanent crowns done. Within few months of permanent crowns i saw the gum of #9 swollen and some pus draining out. Now he said i will have to remove the tooth as it might be fractured and he isn’t sure. As i didn’t want to loose my teeth and just want to make sure with a second opinion.

    In Aug 2011 another doctor said he would like to do an apicoectomy before suggesting anything else. So it was done on #9 and he said the infection is pretty nasty and hopefully it doesn’t reappear and sometimes it takes a couple of apicoectomy. In Dec 2011 i saw the pus drainage again. He saw my x-ray and said nothing to worry i continue to keep the area clean and rinse with warm saline water. Which i have continued to do so and also brush and floss twice daily.

    Towards end of 2012 i started seeing the gap between the tooth # 8 and #9 becoming very prominent with each passing month. #9 has started leaning/moving inwards.

    I have consulted 2 dentists/oral surgeons.
    1. One says we will extract both tooth, graft, wait for 4-6 months and go ahead with an implant. Meanwhile will fix me with a flipper. Gives me no surety that implant will succeed or last for how long.
    2. Another says apicoectomy, but he is not sure if the gap will increase or decrease.

    I m really tired of this as its emotionally draining as well as financially. I don’t want the infection to affect the nearby teeth and further complicate things. I have x-rays for my tooth and would appreciate a very honest and sincere opinion from you if you are willing to check. I will very happy to email it to an id you can provide me.

    Looking forward to your response.

    • Chris says:

      Mithila, I’m sorry to hear that you are having such a difficult time with your front teeth. Based on your description I would not recommend another apicoectomy. I think that removing the teeth and replacing them with implants will be a more predictable plan, both functionally and cosmetically. A flipper is only one option for a transitional prosthesis (temporary teeth while the implants are healing). You may be a candidate for other options depending on several factors. I need to be clear that I cannot give an accurate diagnosis and treatment plan over the internet, even if I were to see some x-rays and pictures. I wish you the best of luck and health!

      • Mithila says:

        Thank you for a prompt response. I’m in Jersey city, NJ. Is there some experienced oral surgeon or concerned doctor you know and will be able to refer or recommend?

  25. Brad says:

    my #10 tooth is broke off and my dentist is pushing for a route canal plus a crown, I know that there is no way I can afford it at this time,Im considering a flipper but kinda worried about what my dentist will say if I ask him

    • Chris says:

      Brad, getting a flipper means extracting the tooth underneath. I would urge you to save the tooth and get a root canal and crown. Don’t feel embarrassed or shy asking your dentist about alternatives and payment arrangements!

  26. Ramon Eller says:

    Can a flipper be pre-made so that it can be used immediately upon extraction of a rear-most molar [in this case #3]?

  27. Pat Morgan says:

    #7 tooth has a post and a cap which has been re-glued twice in the last 3 years. My dentist is recommending an implant. I’m really afraid of getting one.
    Since the cap is already in place on #7, I don’t see why we just can’t reinforce the cap that’s there with only the wings part of the Maryland wings you describe above and just have it run across the three teeth.
    Thank you, in advance, for your answer.

    • Chris says:

      You have an interesting idea but I have a concern. If that cap is going to become loose, even microscopically, then it must be resealed. Bacteria can leak inside and start decay. If this cap was reinforced with wings on the adjacent teeth, you might not notice any looseness, but the bacteria have still penetrated. Thus the reinforcement could be masking the trouble brewing underneath.
      It sounds like there is a real concern with post and crown. Assuming that it cannot be saved, an implant would be an excellent option to replace it. Perhaps you can ask your dentist to speak with one of his other patients who has received an implant. He would have to get their permission, of course, but you might feel better about it if you can speak to someone who has gone through the procedure.

  28. Natasha says:

    I have had a root canal and crown done on tooth #9 10 years ago. Recently it started to shake and now its dandling . My dentist said the x-ray showed no more structure to hold the crown again , when it falls out I have the option of implant. My question is if there is no structure what is it holding on to still 1. and 2 He suggested extraction and temporary filling is there anyway of recementing this teeth until I get my finances together for the implant temporarily .

    • Chris says:

      I think your dentist is saying that although there is enough tooth structure to temporarily cement the crown, there is not enough to predictably keep a crown in place for the long term. If I understand the situation correctly, I would also be reluctant to make a brand new crown on a badly broken down tooth. Speak with your dentist about temporarily “patching” this tooth until your finances are in order. You might also consider extracting the tooth and using a temporary solution as described above while you get your finances together.

  29. Carolyn says:


    I am in the process of getting an implant. I need to wait four months for the crown part. They gave me a flipper tooth to wear (tooth #7); I am allergic to the acrylic – it makes me slightly nauseated and my tissues are puffy. Would it works to get my crown now and go on a soft diet? (I am afraid my oral surgeon will be very much against this as he originally wanted me to wait six months) What are my options? Any advice is appreciated.


    • Chris says:

      Carolyn, it is possible that you are allergic to the acrylic but not likely. The nausea is probably from a form of gag reflex and the puffiness is expected as a part of healing. The flipper might also be rubbing against the area a bit too much which could cause some tissue irritation. I would not recommend getting the final crown before the healing is complete. At this stage the implant is fragile and would be damaged while fabricating and inserting the crown, even with a soft food diet. Speak with your dentist about alternatives to the flipper and see if you are a candidate for something more comfortable.

  30. Elisa Santos says:

    I had all my right upper teeth removed due to an old bridge complication, gum problem, etc… The dentist has put 2 implants in that area and I am now in the healing phase. I also have to use a flipper to replace the missing teeth, but here is the problem: after about 1 minute of having the flipper in my mouth, I just want to throw up, I mean, way beyond the point of a gag reflex which I do have, I actually feel sick. The dentist being aware of my gag reflex had it designed in such a way that it covers very little of my pallet. Yet, I am feeling hopeless. I’ve tried all day to keep it in my mouth, but I just can’t do it. The moment I feel that awful thing, I just take it off. I am completely desperate not knowing how I am going to manage being at work in such situation. Could it be that I have some type of allergic reaction to the flipper material or just a monster gag reflex? Please, give me some light! Thank you

    • Chris says:

      Sorry to hear about your situation, Elisa. I don’t think you’re having an allergic reaction; this sounds like a type of gag reflex to me. Talk with your dentist about alternatives to the flipper and see what you are both comfortable with. Best of luck!

  31. Ned Davis says:

    I have lost the three center bottom teeth at age 69. I have had one implant installed in the center some time back at great expense, and incurred huge expense for bone grafting after the fgirst tooth went six years back. Now I’,m being told to spend $8,000 to set two more implants into the bone and get three replacement fake teeth.

    While deciding what to do I need a temporary aesthetic solution.

    1. Will a snap on suffice, and, if so, how do I buy one and for how much?

    2. What other choices make economic sense to fill this three tooth (bootom center) gap?

    • Chris says:

      Ned, although I am not able to give you a treatment plan without an exam, x-rays, and other diagnostic information, I may be able to offer some advice. The number of implants required to replace missing teeth depends on the number of missing teeth and their spacing. You might be able to replace three teeth with only two implants but it is possible that three implants is a better option in your specific case. As for the temporary teeth, you may be a candidate for Snap On but this must be evaluated by a dentist. The cost for Snap On and other temporary options vary greatly and would all be performed by your dentist. The best answer I can give you is to work with a dental team you trust and explore all of your alternatives with them. Make sure they have clearly explained your needs and options. Best of luck!

  32. Anthony says:

    Hi Chris,

    I already have an implant in #9 and now have to get #8 extracted and after healing an implant. Given this is my front tooth, I really want to avoid another flipper – the one I had for #9 broke occasionally and affected my speech. Since I already have an implant in #9, is one of the bridge techniques even an option?


    • Chris says:

      Anthony, you might be a candidate for a Maryland Bridge which would only bond to tooth # 7. However my first suggestion would be to remove the restoration from the implant at # 9 and create an implant-supported temporary that replaces both # 8 and 9. The restoration on # 9 can be reinserted when the new implant at # 8 is being finished. Of course, I can’t tell if all of this is the right option without examining you, but hopefully you have some ideas to discuss with your dentist. Good luck!

  33. Shauntay Friday says:

    I just found out that I have server Periodontal disease. I was told that four of my bottom front teeth has to be removed. I wanted to know the best options. Implants or bridges. I was told I lost lots of bone and you cant get that back. Upon reading I found something called grafting?!?! What is my best option here. I deal with the public and I’m very young I can’t be without my front teeth. I want something permanent!!!

    • Chris says:

      Shauntay, it sounds like you would prefer an implant option that will keep the teeth fixed in your mouth all day, as opposed to something that you have to remove like a denture. Your dentist will examine you to determine if you have enough bone for implants. If you don’t have enough bone, than a dentist can sometimes replace the missing bone with a procedure called grafting. The goal of the grafting is to build up enough bone so that you can then have implants placed. You may have a lot of options for your treatment, so make sure you spend time learning about your situation with your dentist. Then you can make the best decision together. Best of luck!

  34. Ron Carrasco says:

    Hello Dr. Chris,
    Thank you for this website. It has answered a lot of concerns and questions that I have had concerning a tooth problem I have.
    Thanks again……Ron

  35. Matthew says:

    Hello Dr. Chris,
    I’m writing this in the hopes of a reply from you, as I can’t seem to find answers elsewhere. I had braces for several years, and got them off about 6 months ago. They straightened my teeth and widened a large gap where I was missing a tooth, I think the incisor on the left side. I was given a retainer with a fake tooth in it, and it held my teeth together, while I was planning to eventually get an implant. However, about 2 months ago, I lost my retainer. I thought I’d eventually find it, but no luck. This is the third one I’ve lost, so I didn’t want to ask for another one, and now I am 100 miles away at college. What will happen? Will my gap close? My two front teeth are already starting to lean away from each other, the tips. Will my mouth close? Can I simply try and find a copy of my retainer and jam it back in?

    • Chris says:

      Hello Matthew. Yes, the space can become irregular again. You need some kind of a retainer to keep the space open. You can try to find a dentist near you to make you a new temporary restoration (like a flipper). If you can’t get to a dentist, you may be able to find an over-the-counter nightguard from a drug store to wear as a retainer at night. This isn’t ideal, but it’s better than nothing.

  36. George Webb says:

    I need a flipper instead of a metal partial for my upper mouth. Am I foolish for the $400. quoted difference to get the flipper. I am 87 years old and on no medications, in good health

  37. irene says:

    Hello! Very interesting web site and amazed I am not the only one with dental issues, and having to pay all out of pocket, without insurance. About 25 years ago was so happy to be able to have 8 front teeth capped. Teeth were filed to practically nothing. The passed 5 years noticed the black line appearing on some….they started to come off omg, had them glued back. Making a long story short, am getting a removable partial and getting this done at a dental school. Today he mentioned he will have to fill the two front once with pink stuff on top, since there is a bit of gap…an concerned about that..does this stuff wear off?

    • Chris says:

      Hello Irene. A removable partial denture will often have pink acrylic around the teeth to substitute for the missing bone and gum tissue. This material is part of the partial so it should stay on without a problem.

  38. Alfia Khalioullina says:

    Hello! I am glad I found this site and got some great advices. I actually just had seen my dentist and he made an impressions for the flipper. I will have #12 and #14 extracted soon and get them ready for the implants following the sinus lift/bone graft procedure. I currently have a really nice temporary bridge that stays in place for almost a year and I wanted to have it longer but it can fall off eventually. My dentist recommended Essix that I don’t like (I did not used it when I had an implants done on my other side) so I insisted on something different and he suggested the flipper. Now I think that was not a great choice as well as I would wanted something more stable that could cover my 3 teeth gap on the upper jaw for more than 1 year and more important being able to eat on that side. I am interested in the Maryland Bridge. Do you think the Snap On Smile can be an option for me as well? Thanks, Alfia

    • Chris says:

      Hello Alfia. A three-tooth gap is pretty long, so your options for a temporary are more limited. I think a Maryland bride may not be very stable due to the significant bite forces that would be placed on three posterior teeth. It would have to connect from tooth # 11 all the way back to # 15, so expect that to pop off now and then. A flipper is a decent option in this case. You may be a candidate for Snap-On as well, but it will have to grab on to all of your other teeth on the top just like an Essix appliance. Sure, you’ll be able to wear it while eating (unlike as Essix), but there will be a noticeable cosmetic change as the Snap-On will add thickness to your front teeth. I would say a flipper or a Snap-On are your best bet.

  39. Sarah Berry says:

    Advise would be greatly appreciated!
    4 weeks ago I developed an abcess, 1 loose tooth and was told that I have periodontal disease which has caused some bone loss.
    10 days ago I had two lower middle teeth removed as advised and was given a temporary partial which I cannot talk properly or eat well with.
    In desperation I have had 2 consultations for dental implants with the following advice:
    1) Have two implants placed with one crown made to look like two teeth – the surgeon advised that he could do this procedure anytime from now
    2) Have one implant placed with one crown made to look like two teeth but that I need to wait 4-6 weeks for the bone to heal?

    Both different options – I dont know what to do

    I am mainly unsure on –
    is it better to have done in 4-6 weeks of now?
    one implant or two?
    not sure about a one piece crown?

    Thanking you in advance


    • Chris says:

      Hello, Sarah. In the case of bottom front teeth, you can do two implants or just one. There usually ins’t enough room for two implants in this area, so that’s why we sometimes only do one. If you have room for two, it may be to your advantage to do it that way. Either way there will be two teeth that are made as a single piece. The only difference is whether or not this single peice connects to one or two implants. I’m confused about the healing times you’ve been told so you should double check with the surgeon.

  40. Chanel says:

    Hello Chris, I’m not sure how much advice you can give, but I just wanted to at least ask. I’ve had teeth issues ever since my Gastric Bypass surgery. A lot of decay and extractions. It seems like I can’t keep my teeth anymore and am only in my late 20’s unfortunately. Right now main front teeth are all ready to be pulled. There’s no saving them really. If those are pulled I will literally only have 5 top teeth left – #16, #14, #12, & #2. On the bottom, I have all but #32 & #17.

    I have no dental insurance, and am unemployed. I’m kinda lost because I have no clue where to turn. These front four teeth are in really bad shape and the enamel chips off more and more each day. I used to model part time, but clearly my teeth are ruining that. They are really messing up my self confidence when it comes to interviews because I can’t really open my mouth! Do you have any advice you can give?? Thank you!

    • Chris says:

      Sorry to hear about your dental problems. It sounds like you need a comprehensive work up to be able to learn all of your options. You may be a candidate for a full upper denture. That doesn’t have to be the ultimate solution to your problems, but it can be made relatively quickly; roughly a month and a half. After you get stable and more comfortable, the dentist can begin a more long-term solution for you, such as a new set of teeth that are fixed to implants. As for financing, look for a dental school or dental residency program near you. The care will be excellent and at lower fees than private offices. Remember, you can stretch your care into stages so that it is more affordable. Just getting the tooth extractions and denture on the top will put you in a much better place without breaking the bank. Once you get a job you can revisit the rest of your dental needs. Best of luck!

  41. Larry Baker says:

    Hi. I am freaking out because next week My General Dentist is sending me to have a tooth extraction on #9. #9 And #10 had Root Canals And Crowns since I was 12 years old and I am now 54 due to a bicycle accident. I have had both crowns replaced several times over the years but this time #9 is done and can’t be crowned due to loss of Bone. The Oral Surgeon will be Doing a Bone Graft and in the future after healing an Implant. My Biggest concern as I am in the public eye and I am a divorced Wine Expert who frequents Fine Dining Establishments with women I am dating is the Temporary Replacement that will have to keep me looking good for up to 9-10 months before I get the actual Crown for the Implant. My dentist suggested the Essix to keep the cost down of other types of replacements. He said Theoretically you should take it out when eating but you have to live a normal life and this is not realistic in my situation so he made up 6 trays as they will probably be worn out as you said. I picked up the device today and I looked at it an I just feel like this is never going to work for such a long period of time. I am tasting wine all day long for my job and going to Wine Tasting Dinners 2 times per week..I have to have something that will look good and at the same time be able to be left in while eating and functioning so I don’t scare women and my daily wine customers away with a Missing Tooth in the center of my mouth. Your Suggestions?

    • Chris says:

      Hello Larry. You might be a candidate for a Maryland bridge. It would only be able to be bonded to a natural tooth; bonding to the porcelain of a crown is less predictable and can damage the crown when it is removed. Fortunately, you could still have it only connect to the other front tooth (#8), assuming that tooth does not have a crown. Best of luck!

      • Larry Baker says:

        Yes Chris #8 is a healthy natural tooth with no crown. Can a Maryland Bridge be bonded using only ONE WING since as you said #10 is a Crown so we would only be supported by #8 the non crowned healthy tooth? Good news is that I had my surgery yesterday and the Oral Surgeon did the Bone Graft on #8 which he extracted and he is very confident that the walls are very strong and he might be able to place the implant in One Month instead of 3-4 months of healing. The bad news as expected is I HATE this VISE GRIP Essix Retainer. I have one sip of wine and the whole thing makes my natural teeth PURPLE (Not Good For Public Situations) and seems so ridiculous to replace ONE SPACE with a Vise Grip plastic retainer on your whole upper mouth. Do you agree with the Oral Surgeon? He said the Essix would only be needed to be tolerated for the one month or so INTERIM period until he places the Implant. At that time he agrees with you and to have a Maryland Bridge Bonded in that I can eat and drink with and it will look very well while the Implant is Healing over the longer period of time. He said doing a Maryland Bridge now would be throwing out your money for ONE MONTH and to tolerate the Essix for this short period with the bone graft and wait to have the Bonded Temporary after Implant Placement. I HATE this Retainer and I hope I can get more used to it since I have only had it for One Day but I return to the Pubic Eye in Two More Days. Thanks for all your help Chris

        • Chris says:

          Larry, I agree with your oral surgeon. Bonding the Maryland Bridge works great, even if it’s only anchored to one tooth. However it can be unpredictable when it is taken off. It won’t hurt the tooth/teeth it anchors to, but it may need to be destroyed while it is being taken off. You should hag on for the next month with the essix and then have a Maryland Bridge for the 4-6 months of healing after the implant is placed. By the way, essix appliances are supposed to be removed when eating and drinking because (1) chewing forces can break it, and (2) sugars in food and drink can get underneath the essix and cause cavities in the teeth. That being said, I certainly understand that patients don’t like taking them out and having a missing front tooth while they are in public!

          • Larry Baker says:

            Hi Chris. Houston we have a problem. Apparently my general restorative dentist of 25 years who is well respected by me and the team dentist for the Miami Dolphins Football team and Miami Marlins Baseball team disagrees with you and the oral surgeon. We spoke at length yesterday about this situation and he is clearly against a Maryland Bridge bonding to only one tooth. His words exactly were his experience in times that he has tried that is I would have to keep the essix in my pocket case at all times as it will constantly fall off. He said if the oral surgeon says to go that route he is welcomed to so that because he refuses to choose that option. Since #10 is a crown he can’t use the second wing to bond to a porcelain crown as you said and again reiterated that the Maryland Bridge will pop out constantly being bonded to one tooth from his many years of experience. Soooo his only offer was to think about if I can handle the essix and get used to it in one month. If not the only fixed option he will offer is to sacrifice he crown on #10 and put in a bonded two tooth bridge using the natural healthy teeth and of course after the implant heals he would make a new crown for # 10 and the crown to fit the implant on #9. The bad news is this is very very costly and could cost out of pocket $1800 additional. He realizes you are not supposed to eat or drink with the essix in as you stated breakage and sugars and food getting stuck however he said he maid me up several in case they break as most of his patients eat and drink with or in public for esthetics of a front missing tooth. I feel helpless as I trust my dentist for the last 25 years but yet he refuses to offer the option of a Maryland bridge bonded to #8. So for him it is spend the $1800 or just live with the essix for 7 more months and rinse after eating with it in and keep it clean. I really wanted more of a fixed solution after the implant was placed but don’t want to change a dentist who I consider the best after 25 years. What do I so as I literally hate this essix and think all day of going home and removing it like a bad pair of shoes

          • Chris says:

            I certainly don’t want to undermine your dentist here. I haven’t done an examination on you, so I could be missing something here. However I will say that a single-wing Maryland Bridge absolutely can work. I’ve done it. I used to struggle with Maryland Bridges as well. They would keep popping off and it was very frustrating for both me and the patient. However I realized that I was only cementing them in place, not bonding them. I played around with some designs and also started etching, bonding, and using flowable composite as a luting agent. That’s starting to get a little technical, but the point is that I chemically bond these things to the teeth. They stay on so well that I typically have to cut them off when it’s time to remove them. This is done carefully and without damage to the other teeth.
            Again, I don’t want to undermine your dentist. There are different materials and techniques out there and dentists need to know which work best in their hands.

          • Larry Baker says:

            Hi Chris
            I don’t mean to keep beating a dead horse. I realize you don’t want to undermine my dentist so obviously with such a loyal following even for two professional sports teams to have him as their team dentist for 25 years and for myself I trust him 100% and do not want to see any other dentist ….so I credibly don’t want to undermine him either. He didn’t blow me off when I expressed my concerns but when suggesting chemical bonding with one wing and etching he listened however he said he himself is not offering me that option. I feel really strapped because the dentist I trust understands my hatred and being so uncomfortable in the essix but is only offering 3 options. Get a 3 crown bridge which he thinks would be horrible dentristy to file down two natural healthy teeth. Choice two would be to see after the bone graft heals and the oral surgeon places the implant to see of I have become more comfortable with the essix which he has made 6 backups for me knowing although not a good idea to eat or drink wine with them the reality is in public I will and probably crack a few of them so he will have new ones already made to get me through the 4-6 month implant healing phase. Most importantly the only fixed option he will offer to me at that time is to sacrifice the crown at #10 which is old and not the best match anyway and cement a two tooth type bridge that will look great and not have to be removed and will not pop off. When the implant is healed he would have to remake permanent crowns so in summation on top of all this expense for extractions and bone grafts and essix appliances and implants choosing this fixed temporary non removable option will tack on an additional $1600 out of pocket which my dentist was trying to avoid me having to do. So I am caught between a rock and hard place. I will never be able to go another possible 6 months or more with this easix and yet my dentist of 25 years is only willing to do one non removable temporary solution which I cant afford. Even if you were located in south Florida Chris it don’t think I would allow you to do a one wing Maryland because I don’t want to go behind my dentists back as do you. So it’s either pay the big bucks out of my savings or be miserable with this very annoying and uncomfortable essix appliance which he adjusted but I hate it. It’s like a pair of bad shoes you can’t wait to get home and take off your feet. I spend all day in a public job dreaming of getting in my car to go joke and remove this plastic tray out of my mouth. I have no choice do I ??

          • Chris says:

            You and your dentist are most comfortable with two options (1) stick it out with the essix, or (2) make a two-tooth bridge temporarily. I have done both of these options for my patients, depending on the circumstances. Option #2 is not a bad one since it sounds like you wouldn’t mind improving the cosmetics. Yes, it does mean you would have a higher expense, but that is the price of comfort for you. If you really are miserable with the essix and you don’t think you can get accustomed to it, you might be well-advised to go with the two tooth bridge option. Life’s too short to not be comfortable and happy!

      • Larry Baker says:

        I agree Chris…Thanks for the approval which none of my friends or family are giving me. I have wanted to get that #10 Crown replaced for cosmetics for years now but never had the money. Since I am going for the Implant in #9 and spending a decent amount of money to do the right thing and not sacrifice filing down healthy teeth and My Teeth will be professionally Whitened by my Dentist before the Permanent Crown on the Implant is Matched…I might as well be comfortable for 6 months with his temporary solution and in the end having #9 and #10 Being a perfect color match to nice White Teeth…I will not only get rid of that Essix but in the final outcome I will have the Cosmetic Smile I always wanted and more self confidence. I wouldn’t have needed your advice if it weren’t my friends and family telling me I was crazy to spend that kind of money for a temporary 6 month Period and deal with the Essix and save your money. Hearing you agree with me, the money will be well spent when everything is in place and I have a great happy comfortable smile. You’ve made MY decision a lot easier…Thank you for everything..Larry

  42. Ava says:

    Hi Doc,
    I had a root canal done on tooth number 9 eons ago. Got a crown, it fell and then got a new one in 2006. It had been doing fine till recently and felt loose. I went to my dentist in May, he checked and said it was fine..
    Recently, it felt looser again,and this time over a check up, I was told (it came off easy when he tugged), I needed an implant… :(

    Visited his implant guy, who said, I’d have to get the tooth extracted, some graft work done, then wear the flipper (there is a 10% chance that the implant can go in right away, but can only know that after the extraction).
    So flipper for 3-4 months, then the implant for 3-4 months and finally the crown.

    I was told that if I wanted a temporary crown after the implant, i could get it, but it would cost about $500.

    So, all in all this is costing me about $4800 (extraction, graft work, x-rays, flipper, and final crow).
    An additional $500 if I get a temporary crown.

    Does this seem right? (Process and cost)
    If the flipper going to be depressing and will it all be worth it in the end?
    Can I eat soft foods with ‘Flipper’?

    And eventually can I ‘BITE’ with my front teeth (once the implant is on?)

    Thank you so so much for you time!


    • Chris says:

      It is certainly not for me to determine the fees for another dentist. This person may be extremely experienced and skilled and thus a higher fee may be warranted. The fees you are stating are not unreasonable for all of that work. Personally, I am not a fan of flippers, as you can see. One of the main reasons I’ don’t like them is because patients are uncomfortable with them. You will be able to eat hard and soft foods, but it can be uncomfortable to wear. You may be a candidate for an alternative temporary solution, such as a Maryland Bridge, which can be worn while you heal. It is a great idea to wear a temporary crown on an implant after it has healed so further develop the cosmetic result. You’ll be able to eat and clean your final implant crown just like your regular teeth. With proper hygiene, you should be able to keep the final implant crown for a very long time, so spending a little extra on a temporary to help it look great is money well spent!

  43. It all started when my husband fell and broke his 2 front teeth. Pre-
    vies he had gum surgery . He had a bridge after that for many years until it broke this march. The Dr. said it was possible to do
    another bridge, even there was not a lot to work with. Well it was very expensive and now the bridge fell down the 2nd time. Installation in march, fell down in june re-cemented, fell again in nov.. So now the Dr. says it is not holding. What should we do.
    He really does not need all that stress, since he also is battling a decease..

    • Chris says:

      I’m sorry to hear about your husband’s dental and health problems. Although I don’t know about the status of his remaining teeth, it sounds like the most predictable option would be to have dental implants to replace the missing teeth and any teeth that cannot be saved. A less expensive option would be to have a removable partial denture.

  44. Lora says:

    How do I find a dentist who offers some of the options other than a flipper? I had a cantilever on tooth #11 and the one next to it. Tooth #11 failed and has been extracted so I currently have two teeth missing in front. My dentist gave me flipper, which is a disaster. It’s extremely painful to wear and it flops up and down so it’s hitting the extraction site to some extent. This dentist does not offer any of the other options and I would like to find someone who does. I’ve looked on the web, of course, but no luck. I’d appreciate any help you could provide.

    • Chris says:

      Lora, this is very tricky. It is possible that you are not a candidate for any alternatives due to the condition of your other teeth. However it is also possible that your dentist is just uncomfortable with the techniques involved with the alternatives. I would encourage you to let your dentist explain why you may not be a candidate for the alternatives. If he/she just doesn’t offer the alternatives, ask them if they can recommend a dentist who can provide it. Hopefully the dentist can expand their skill set and everyone will work together to get you the best care possible.

  45. Taylor says:

    When I was 13 an oral surgeon performed surgery to put buttons on my two eye teeth to pull them down into place. However, he said he couldn’t get one and he didn’t want to get one without the other so he took both of my teeth out (without asking my parents’ opinion). It wasn’t such a big deal then because I still had my baby teeth but when I was 18 I felt it was time to get rid of those baby teeth. My dentist said that he could pull those teeth and give me a flipper. He informed me that it wasn’t anything permanent but it should do the job until I could get something else. As a college student, we knew implants would be too costly. The dentist did a very good job with the teeth and no one could tell they were fake. However, after 2 years of having no problems, one tooth broke off while I was eating. I took it back and the dentist put it back on. It wasn’t a week later and the tooth broke again. Once again, we took it back and the dentist put it back on but you could tell the tooth was fake because they tried to make it more durable. Within another 2 1/2 weeks the tooth broke again but for months I was able to use Fixodent to hold the tooth on the flipper until we found a better option. I go to school away from home so finding time to go to my dentist wasn’t an easy task. Just recently I lost the tooth and need it replaced. However, we aren’t sure what the best option is for me. Implants are still out of the question, at least for the next year and I would like something more durable than another flipper. Over the summer, I had my wisdom tooth pulled and the oral surgeon said that I was a very good candidate for implants because of my good bone structure from having my baby teeth for so long. But since I’m not quite ready for the cost of those, I need something that will last until I can get them. I still wear the flipper since there’s one tooth on it and only missing one tooth is better than missing both of them. I’ve been to many different dentists over the last five years because we have not been satisfied with any of them and they all seem to have different opinions on what I should do. What would you recommend would be the best option for me?

    • Chris says:

      Taylor, as far as I can tell from your story, you might be a good candidate for a Maryland Bridge (described above). They can last for years while you save up for implants and they will be much more comfortable than a flipper.

      • Taylor says:

        Do you have any recommendations for a dentist in the St. Louis or Southeast Missouri area? I have not had any luck with my dentists in the past.

  46. Jack says:

    What is the ADA code for an Essix retainer and what is a fee range? Do most insurances reimburse for this procedure?

    • Chris says:

      I would use “Interim Partial Denture,” which is either a D5820 for the maxilla or a D5821 for the mandible. The definition is: “A provisional prosthesis designed for use over a limited period of time, after which it is to be replaced by a more definitive restoration.” Note that this is the same code use for a flipper.

  47. Gary Allen says:

    I need a tooth implant from #12 and have a history of poor tooth due to fear and neglect which I have reversed recently.

    I was told that tooth #12 should get an implant at as well as #13 will likely require a root canal at some point and it would not be worth the effort but get both the implants at once.

    I was offered the flipper, but after reading your site a temporary brdge sounds much better. Am I likely eligble?

    • Chris says:

      It really depends on the health of your teeth next to the implant sites. There is no one solution that works for everyone, of course. You should speak with your dentist about alternatives to see if you are eligible. Good luck!

  48. Dr.Ala'a says:

    nice post,
    about the Essix, what is the recommended thickness and shall i use hard or flexible sheet ?

    thank you

    • Chris says:

      There are differnet thickness of Essix material and each can be used for an implant provisional. It comes down to personal preference. THe thicker you go, the sturdier it will be but also less comfortbale to wear and less cosmetic. The thinner you go, the more fragile it will be but more comfortable and more cosmetic.

  49. Steve says:

    Hi Chris,

    I missing my upper lateral incisor and have a Maryland Bridge. I’ve had it for about 14 years (got it when I was 16) and it’s been glued back either 2 or 3 times. The next time it falls out I’m considering either a fixed bridge or implant. Right now I’m leaning towards the implant. Since the rear of the anchor teeth were prepared and some enamel was removed, how well do they hold up? Will the cement that is leftover wear away naturally so there isn’t any more reduction?

    Thank You

    • Chris says:

      Steve, you may just need to have the backs of those teeth polished/smoothed. If the preparations are deep, the dentist can place tooth-colored fillings (aka “bondings”) to restore them to theor original shape.

  50. Natasha says:

    Hi, Chris. I have congenital missing lateral incisors. I recently replaced my flipper with two Maryland Bridges. After reading so much about this type of bridge failing I have been experiencing a lot of anxiety and depression. One wing on one of the bridges doesn’t feel right. When pressure is put on the one tooth, I feel a tightening feeling which releases when it is pushed back. Basically, it feels like there is some movement on that one wing. I went to my dentist and he said that it seems fine and that if one wing ever debonds the other wing will be enough to hold it and he can just put a little cement on it. That doesn’t seem right to me. What I understand is that in that event the bridge should be removed and prepared in the lab. This bridge is supposed to be a permanent solution for me. I am only 20 and a student, so I need to feel comfortable that what I have now will not fail me. Is this fear reasonable? What is the best thing to do when the bridge only debonds on one side? Your help is very much appreciated.

    • Chris says:

      Natasha, it is true that these can be held in with only one wing. In fact, some dentists prefer to only place them in with one wing to start with. The theory is that bodning the bridge to two teeth might acutally be weaker than only one because the two anchor teeth move independently of one another when you bite. This can lead to loosening and debonding. I think that is very plausible and may be a factor for some patients depending on their specific factors (strength of bite, chewing habits, position of the teeth, etc.)

  51. Jeffrey says:

    i getting tooth #6 extracted need an implant gonna cost me 2605 .. i was wondering is there any other dental work i can get done for that tooth since its very expensive for me ? id appreciate a response thank you ?

    • Chris says:

      The alternatives to an implant are a fixed bridge (which means they cut down the adjacent teeth and fit them for connected crowns) and a removable partial denture (which could also replace additional missing teeth, if there are any). Which option is right for you depends on a lot of things, not just cost. The dentist will evaluate the health of your remianing teeth, your bite, the prognosis for the treatment, and so on. Best of luck!

  52. mar says:

    Hi there!
    Have just had a front tooth extracted and was fitted with a flipper. I’m a teacher in Kuwait and don’t fancy having this for my up coming holiday while waiting for an implant. Texted my dentist about ‘snap it’ and he told me it costs a lot – nearly $2000. This would be too much for a temporary fixture. He did mention a bridge, but what kind of bridge would this be and would it interfere with healing for implant?

    • Chris says:

      Snap On can be costly, depending on where you live. I’m not sure what kind of bridge he is offering; perhaps a Maryland Bridge?

  53. Joanne says:

    Does a Flipper work well if 6 upper teeth are going to be removed to get ready for implants? This is what my Dr suggested I’m kinda confused

    • Chris says:

      Yes, it can, but every situation is different. Ask your dentist if there are any alternatives. But 6 teeth is a lot to be missing so you may only be a candidate for a flipper.

  54. Michael Gagaoudakis says:

    Flippers work great as long as you do the case right. I’d recommend that you take a look at grafting protocols for anterior teeth in Arun Garg, Mike Pikos, and Carl Misch’s grafting books. Most complications with flippers occur because of inadequate graft coverage or inadequate graft selection. If you want to be a “nationally recognized speaker” make sure you have the guts and the knowledge to do so. This is a very misleading article.

    • Chris says:

      I’m sorry you disagree, but I am still not a fan of flippers. I have found that it is fairly rare for a flipper to cause a hard or soft tissue graft to fail, but it is certainly a cause for concern. Ask most oral surgeons or periodontists and they will be happy to hear that you can provide an alternative to a flipper.
      But I think the greatest reason to find alternatives is due to patient comfort and setting cosmetic expectations. Just look at the long list of comments on this post from patients who desperately want to get out of flippers. And the cosmetic issue is real; does your flipper reproduce papilla in acrylic that your final restoration won’t have?
      I have lectured nationally and internationally for years on this very subject. I must say that you are the first dentist I’ve encountered who has defended flippers. Do you really find them to be superior to the alternatives?

  55. Donna says:

    I just had upper tooth #5 removed due to infection. It was the first tooth in a 4 tooth bridge. The dentist sawed off the bridge and left a cap on the last tooth. His recommendation to me is to have two implants and then a 3 tooth bridge. He also recommends a temporary bridge from the canine to the capped tooth from the bridge. I was hoping that this tooth would not have to be recapped. Also the canine has a filling but is not giving me any problems at this time. In addition to the cost, it bothers me to put a crown on what may be a good tooth. Any suggestions? He doesn’t think a flipper is a good option.

    • Chris says:

      I’m having difficulty visualizing the exact scenario, but I would need xrays and an exam to tell you whether or not a tooth needs a crown. I recommend speaking with your dentist about the possibility of not having a crown and see what the pros and cons are of your alternatives.

  56. Haleh says:

    Hi Dr. Salierno, I recently had #9 implant removed due to an infection. It was removed and a bone graph was placed in the area. The adjacent teeth are implants as well.They seem to be ok and holding in place, however I have had a lot of bone loss there too along with my gums and the gum graphs that were placed there some years ago have receded exposing much of the implant. Just to be clear, I keep my mouth clean, gums & teeth flossed, brushed and have cleaning every 3 months since my maxo-facial surgery in 2005. I do what I can on my end to keep things healthy, but (-) dental health and bone loss runs in my family and after 4 bone graphs, well now 5, I am at a loss of how to keep my bone. If I could go back in time, I would have requested a fixed bridge across the front of my teeth from #6 that has an implant currently to #13 which does as well; I could almost do this now, however #4 & #5 are my own teeth and are healthy. What do you suggest? What would you do? Thank you!

    • Chris says:

      It is unusual to lose bone around implants with good hygiene, as you described. I recommend getting a second and third opinion from periodontists in your area. We need to find out what caused the bone loss. A periodontist can carefully review your medical history, hygiene history, etc. Based on what we find, we’ll know what the next steps should be.

      • haleh says:

        I have now added a water pick to my regimine. It’s become almost excessive, but necessary, as to the oral hygiene I participate in for the past ten years; and it’s uncomfortable when I hear the Oral surgeon, the periodontist and general DDS say ” we just have to keep it very clean.” My hygienist knows how clean everything is, and my gum perio#s are 2’s and 3’s, except for my anterior implants which have greater depth due to gum and bone loss.

        I had a body bone density scan today and have been taking 50K IU of VD2 once week due to VD Defincency. My dad had all his teeth removed in his 30s, and so have some of his sisters. I am wondering if there is a correlation, and what I can do to STOP it.

        I now am wearing a flipper where #8 implant was removed :-(, and the periodontist mentioned a bridge in the future. I do not want to lose any more bone at all, and so a bridge doesn’t sound good to me for that reason. I would like to add a mass amount of bone/autograft to my entire mouth if possible. I saw my oral surgeon and he suggested a small bone graft where the implant #8 was removed saying the allograft that was placed at the time of removal will dissolve –as he has witnessed before on me. I asked about an upper jaw replacement and he said I am not a candidate for that.
        My mouth/teeth is a quilt of my own teeth (with short, short roots), a couple crowns, several implants ( whose tread shows becomes of gum recession), a couple bridges. My ridge is sight and what bone of do have acceding to the x-rays and CT scan is not enough to do anything with.
        I’ve been searching online for EXPERTS in bone.
        *The Oral Surgeon suggested another bone graft, heal, then implant again.
        *The periodontist suggested a bridge
        *The DDS had the flipper made and is waiting to hear from the perio.

        I am making appointments with DMD’s for consultations to hear what they would propose. That’s going to get expensive though, so I am looking online for suggestions as to where I can find an expert to help me obtain/grow more bone AND not lose it anymore. WHERE do I find the experts Dr. Chris?

        THANK YOU and Onward to 2015!

        • Chris says:

          Sorry to hear that you are getting different opinions. I agree that you should seek additional consultations to (1) learn more about your options, and (2) potentially find a new dentist that earns your confidence. Cases like your rarely have a single treatment option; you will likely continue to hear different opinions about what to do. That’s fine… it’s good to have options. The important think is that you learn the pros and cons of each. Talk to each dentist about the other plans you’ve been offered and see what they think. Good luck!

  57. Christy says:

    Unfortunately, I lost numbers 7,8,9, & 10 due to a car accident. I don’t have the best of teeth in the first place due to heretics, Mt. Dew, and sensitivity. I’m also on Medicaid at the moment because I lost my job due to the accident. Medicaid is saying it could be 7 months before I can even get a partial. I’m devastated because I’m a highly intelligent woman who typically has great jobs but who is going to hire me if I am missing my front teeth? I’m not an idle person, I want to work and stay busy. This has even impacted our finances. I don’t have the money to buy something temporary and I definitely don’t have the time to wait for Medicaid to approve something permanent. Do you have any suggestions? Is there anything I can do, even if it is temporary? I just want to be presentable for interviews. Please help me. I’m begging for your advice.
    Best Regards,
    Christy Yerrick

    • Chris says:

      A temporary removable, also known as a flipper, ma be the best short-term solution to get you ready for interviews. It won’t be the most comfortable solution, but they can look good and are pretty affordable. Good luck!

  58. Joanne says:

    Hi Chris.
    I have a 6 tooth upper bridge which I’ve had for about ten years. Sometimes, it has come loose and the dentist I used,who has now retired, would just tap it out, clean it and my mouth and re glue it back. So now,the new dentist, sent me to a periodontics who suggested getting implants. with an estimate that was insane, why cant I just keep my bridge the way it is? I have no pain..no bleeding..no soreness and I like the way it looks
    Thanks in advance for your response

    • Chris says:

      It’s not healthy to have a bridge that keeps getting loose. You could be getting tooth decay underneath, for one thing. It sounds like the dentist is recommending a healthier, more long-term solution and that’s great. You probably are not a candidate for a new bridge, so the alternatives are implants or a removable bridge (aka partial denture). If my assumptions about your case are correct, implants are usually the best way to go in terms of cosmetics, function, and comfort.

  59. Shaun says:

    Hello Dr. how kind if you to do this for those in need. I have two false gerontology teeth ten Years old no teeth between my fangs, my fangs grew as close as they could but still formed a gap. Can I get a snap on smile or a flipper. Every dentist I ever went to says “YOou have bigger problems in your mouth, lets deal with this before cosmetic”. This dentist walk around with a smile I can’t.

    • Chris says:

      I can’t be sure without seeing you in person, but the dentists may have a valid concern. If someone has missing or failing back teeth then it would be a bad idea to replace the front teeth first. The replacement front teeth may break or fail without proper support in the back. It would be a waste of your money! Like I said, I can’t be sure that this is what is going on in your mouth.
      The important thing is to find a dentist that you trust. Someone who takes the time to completely explain what is going on in your mouth. Your priority is to replace your front teeth and that’s fine. But you must get treated in a comprehensive manner that accounts for all of your dental conditions. Best of luck!

  60. Sara says:

    Hello I had adult braces crowns and bondings done to my teeth. I wear night time retainers and overall I have okay teeth. I lost a crown while eating. I.noticed below the crown there really was no tooth. My dentist said from – xrays taken it was a fracture and tooth number 20 of the lower jaw has to come out. I am going for an implant. I went to the office for restorations to be.made for a single tooth what? partial?flipper?i am Not sure the dentist said it does have wires on both sides of the tooth and the wires are clear.My tooth next to 20 is a crown the other tooth is my own.Not sure about a Maryland bridge.
    Also I am depressed. Because I have a job that requires speaking. On stage and quite a few events this spring and summer. My dentist told. Me like 7 months to get an implant. So 2 questions First: what temporary tooth will I get after the tooth extraction? Second Will the oral surgeon do anything to start the implant process. I know I will not get the implants right away but want to know does the oral surgeon at least set the post or do bone grafting Thanks this is depressing.

    • Chris says:

      Sorry to hear about your troubles. Do not be afraid… there are creative ways to keep you comfortable and temporarily replace your teeth. I can’t recommend any specific treatment without seeing you in person, of course. However your dentist should be able to provide you with a few options and the pros and cons of each. Make sure you have a detailed conversation with him/her before beginning treatment!

  61. William Shelley says:

    I will be having a front tooth removed, do you know of any Dentist in the Roseburg Oregon area who is using the snap on method or a bonded two wing Maryland , as it will be a while till I can do an implant. The teeth on both sides are good and I would rather not have them ground down for a bridge. Thanks

    • Chris says:

      It sounds like a Maryland Bridge might be a better bet for you, though I obviously can’t be certain without doing an examination. You should speak with your dentist prior to having your tooth removed!

  62. Rachel says:

    My flipper broke and I have the tooth. What would it cost to fix the flipper?

  63. I have one tooth lower front that needs to be removed I had a root canal done many years ago my dentist is only offering me a flapper I know now there are other options how do I get in contact with the wright dr , to help me I have dental ins. i”m going with an implant but don’t want the open front space !!!!!!!!!!! who can help me ?

    • Chris says:

      You can find a list of dentists at mouhthealthy.org. Schedule a consultation with them to discuss your options. Best of luck!

  64. Aaron says:

    Just had an implant placed to replace incisor. Previous experience with flipper not a good one. Both adjacent teeth are crowns. Is there any Maryland style bridge that can work as temporizing measure?

    • Chris says:

      Maryland bridges are tricky if both adjacent teeth are crowns. I’ve done it, but you have to be prepared for possible chipping/damage to the porcelain of the adjacent crowns.

  65. Katie Garry says:


    I broke my #4 tooth and unfortunately, it cannot be saved. It is in my smile line and I just cannot have a missing tooth. I was quoted on getting a socket preservation if I don’t have enough bone, or placing an implant if I do…both can be done at the time of extraction. I would have to wait 6 months before they can place the actual crown on the implant. In the mean time, what would you recommend to fill the space while my implant/socket preservation is healing? I’ve heard that you can’t get a flipper because it touches the healing site and it can cause complications. I have very weak teeth due to soft enamel…I don’t know if that matters or not. I would appreciate any advice you could offer me. Thanks so much!

    • Chris says:

      You probably have a few options, including a flipper or a Snap On. Getting a bone graft is a good idea regardless of what you choose to replace the tooth (bridge or implant).

  66. Fran Barlow says:

    Does an implant supported bridge automatically mandate a pink fake gum attached??? I met with surgeon to have 1 implant.The surgeon proposed 6 upper front implants after he removes 2 good teeth and two fragile ones. No bridge, etc was discussed. I was shocked but accepted the plan. While at my family dentist, he called the surgeon telling him to prepare 5 implants and a bridge listing off many tooth numbers and extractions that led me to tears. I had no idea what was going on. I saw photos & the existence of a FAKE GUM was never mentioned or observed.Your information has saved me from suddenly being approached with teeth connected to a PINK FAKE GUM. I do hope that “Fake gums” are mentioned and made very clear to patients.,,even medical professionals like me who has no clue about this expertise. Thank goodness for this article!!! If “pink fake gums” are the case, the procedure scheduled on 11-24-2015 will be CANCELLED. Thank You!!! Unable to attach Photo : The tooth #6 (good)-8(good)-9(fragile)-10 (good) to be extracted. #7 was a beautiful tooth that became very loose over 2 years and is gone. Again, Thanks for all of the info!! BTW. I consider both dentists excellent with different opinions?

    • Chris says:

      “Fake gums” can be used in temporary restorations (like a flipper) and in final restorations. Sometimes a dentist can anticipate the need for this and sometimes we don’t know until we are finishing the case and we discover a cosmetic need for it. Despite our best planning efforts, the human body can throw us a curve ball. People’s anatomy can be different than anticipated, healing gums can shrink back further that we thought, and so on. I wish you the best of luck as you work with dentists to anticipate these outcomes.

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